Identifying the costs associated with changing the clinical management of falls

Debbie's case study was completed in 2015 and reflects 2015 prices

Nationally, falls cost health and social care £2 billion per year; account for 4 million bed days; and up to 75,000 hip fractures. From the age of 65 years there is an increased risk of falling, with one person in three aged 65 years or over, falling at least once a year and 50% of people aged 80 years falling at least once per year. Falls and fractures can result in death or major changes to function as the individual may lose confidence to continue routine activities of daily living, lose functional ability and develop fallophobia, in itself an independent falls risk factor.

South Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT) Allied Health Professions Lead, Debbie Moores, noted that when a service user falls in this mental health setting, and a fracture occurs, the direct costs for the interventions is borne by the neighbouring acute Trust and wider health and social care economy, as the service user is transported to the acute hospital, who provide the required surgical interventions and care before transferring 50% of SSSFT service users who fracture, to an EMI nursing home.

In order to reduce the incidence of falls, Debbie led the implementation of Trust wide falls prevention strategy. A 6 month pilot of a new Falls Checklist successfully reduced the number of falls at SSSFT by 23.6%. It was soon agreed to extend the Falls Checklist across the organisation, with training delivered by Matrons to Ward Managers, Band 5 and Band 6 nurses.

Debbie found that by investing £13,911, the Trust significantly reduced the total number of falls, and demonstrated both clinical and cost effectiveness. By preventing one patient falling fracturing their hip, the system avoids £34,258 (2015 values). These costs include ambulance costs, assessment and treatment in A&E, surgery costs, high dependency unit costs and rehabilitation service in the community, with the bulk of the costs borne by the acute hospital sector. Local data suggests that Debbie's intervention has the potential to avoid nine patient's falling and incurring a hip fracture, saving the local economy £308,322.

Debbie's findings are particularly relevant in the context of increasing numbers of the population diagnosed with cognitive impairment, who may require admission to mental health inpatient units, where falls are commonplace and costly.